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STEP THREE: ADJUST/ACCOMMODATE for EDUCATORS continued.
Typically, student’s symptoms only require 2 to 3 days of absence from school. If more than 3 days are missed, call a meeting with parents and seek a medical explanation.
Teachers, please consider categorizing work into: Work REMOVED NEGOTIABLE
Work REQUIRED
Consider removing at least 25% of the workload. Consider either “adjusting” workload (i.e. collage instead of written paper) OR “delaying” workload...however, be selective about the workload you postpone. Consider requiring no more than 25% of the workload.
Academic adjustments fall within the pervue of the classroom/school. They are NOT determined by a healthcare professional. The teacher has the right to adjust up or down academic supports as needed, depending upon how the student is doing daily. Medical “release” from academic adjustments is not necessary. PHYSICAL: • “Strategic Rest”scheduled 15 to 20 minute breaks in clinic/quiet space (mid-morning; mid-afternoon and/or as needed) • Sunglasses (inside and outside) • Quiet room/environment, quiet lunch, quiet recess • More frequent breaks in classroom and/or in clinic • Allow quiet passing in halls • REMOVE from PE, physical recess, & dance classes without penalty • Sit out of music, orchestra and computer classes if symptoms are provoked
Symptom Wheel Suggested Academic Adjustments
PHYSICAL ✺ headache/nausea ✺ dizziness/balance
problems sensitivity/ blurred vision ✺ noise sensitivity ✺ neck pain ✺ light
COGNITIVE TROUBLE WITH: ✺ concentration ✺ remembering ✺ mentally “foggy” ✺ slowed processing
EMOTIONAL: • Allow student to have "signal" to leave room • Help staff understand that mental fatigue can manifest in "emotional meltdowns" • Allow student to remove him/herself to de-escalate • Allow student to visit with supportive adult (counselor, nurse, advisor) • Watch for secondary symptoms of depression and anxiety usually due to social isolation and concern over “make-up work” and slipping grades. These extra emotional factors can delay recovery
EMOTIONAL FEELING MORE: ✺ emotional ✺ nervous ✺ sad ✺ angry ✺ irritable
SLEEP/ENERGY ✺ mentally fatigued ✺ drowsy ✺ sleeping too much ✺ sleeping too little ✺ can't intitate/ maintain sleep
Read “Return to Learning: Going Back to School Following a Concussion” at nasponline.org/publications/cq/40/6/return-to-learning.aspx
COGNITIVE: • REDUCE workload in the classroom/homework • REMOVE non-essential work • REDUCE repetition of work (ie. only do even problems, go for quality not quantity) • Adjust "due" dates; allow for extra time • Allow student to "audit" classwork • Exempt/postpone large test/projects; alternative testing (quiet testing, one-on-one testing, oral testing) • Allow demonstration of learning in alternative fashion • Provide written instructions • Allow for "buddy notes" or teacher notes, study guides, word banks • Allow for technology (tape recorder, smart pen) if tolerated
SLEEP/ENERGY: • Allow for rest breaks –in classroom or clinic (ie.“brain rest breaks = head on desk; eyes closed for 5 to 10 minutes) • Allow student to start school later in the day • Allow student to leave school early • Alternate "mental challenge" with "mental rest"
Interventions: Keep in mind, brain cells will heal themselves a little bit each day. Students should be able to accomplish more and more at school each day with fewer and fewer symptoms. Therefore, as the teacher sees recovery, he/she should require more work from the student. By the same token, if a teacher sees an exacerbation of symptoms, he/she should back down work for a short time and re-start it as tolerated.
Data collection: How the student performs in the classroom is essential data needed by the healthcare professional at the time of clearance. Schools should have a process in place by which a teacher can share observations, thoughts, concerns back to the parents and healthcare professional throughout the recovery. Healthcare professionals should REQUIRE input from teachers on cognitive recovery before approving the Graduated Return-to-Play steps. (See Teacher Feedback Form in APPENDIX.) Parents should sign a Release of Information at the school and/or at the healthcare professionals office for seamless communication between school teams and medical team. Supplemental materials and downloadable forms for teachers may be found at RockyMountainHospitalForChildren.com.